Creating Flexibility for Nurses
How it was then, where it is now, and where it's going next
Photo by Patty Brito on Unsplash
Clipboard Health’s goal is, put concisely, to help health care professionals have better lives. There are several ways we try to do this; for some of the people we serve, making more money is their primary goal. Some people are looking for more flexibility in their schedules, or the ability to choose where they work. Some people simply want the ability to work more hours than are available at their current job, or to work less than a defined full-time or part-time role would allow. We want them to be able to do all these things, and one of the first steps to doing that is understanding the history and context of the people we are trying to help.
Through most of history, a medical professional would have primarily served from a single practice and provided service to a particular community. This might have looked like a doctor or nurse working from a single building or location or sometimes involved them visiting patients in-home, but there was generally some level of permanence in how they worked. If a nurse found themselves serving an entirely new group of people, this usually would have meant they themselves had moved residence to a new city or town. When we first see the idea of a healthcare professional moving from place to place often, we usually see it in the context of military personnel; a Roman Medici would follow a particular set of troops around, rendering what aid he could to injured soldiers. Besides that, most medical professionals stayed put.
That military connection is important, because it was in a military environment that we first started to see the concept of medical professionals moving from area to area to temporarily bolster existing medical personnel. Florence Nightingale, for instance, took a group of 38 nurses to help overworked medical staff serving troops fighting in the Crimean war. By temporarily increasing their numbers and bringing her own expertise into play, she was able to have a massive impact on the sanitation of medical facilities and the outcomes of the patients there.
With Nightingale, we began to see the medical world levering increased mobility to get help where it’s needed most. But not until the 1970’s do we start to see medical staff traveling as something meant to help both the patients and the practitioners. At that time, it was noted that shortages of doctors outside of cities was often attributable to the fact that those doctors often were “trapped” in their practice; since they were the only physicians in the area, leaving would leave their patients without care. Doctors were organized to provide temporary relief for rural doctors. This created the concept of Locum Tenens. the practice of medical professionals stepping into temporary roles to either relieve someone there of duty or to shore up short-staffed facilities.
Driven by a nationwide-nursing shortage, by the end of the 1980’s locum tenens had expanded from a practice primarily of doctors relieving other doctors to a fully fleshed system of redistributing nurses from areas with some level of surplus to areas badly in need of their help. Travel nurses pack their bags, go to a new city and check in for a period of weeks or months, typically at a higher rate of pay. It’s become a way to stretch an increasingly burdened number of healthcare professionals to cover an increasingly burdensome shortfall of needed patient care.
More recently, *per diem* nursing helped to fill staffing gaps further. A nurse working on a per diem basis is available to work at any number of different facilities, taking shifts on a day-by-day basis as supplied to them by an agency, and providing even better flexibility for hospitals and care facilities to bolster their staffing on an as-needed basis.
This is the world Clipboard Health stepped into, one that had progressed from health care workers often living and working in the same context their entire careers to one where nurses move job to job often, either as traditional hires, travelling nurses or nurses to accept short term, day-to-day work on an ad hoc basis. If Clipboard Health wanted to help health care professionals, it would necessarily involve an improvement over this status quo.
Where Clipboard Makes a difference
Make no mistake: leveraging mobility and communications to produce a flexible, mobile healthcare workforce had huge upsides before Clipboard Health came to the table. Already, nurses had increased flexibility; where once they could only work a different place by finding an entirely different and usually full-time job, now they were able to travel to new places and see new things as part of their normal work, usually at a higher rate of pay. If they had fairly flexible schedules, per diem work gave them access to another alternative way of working without leaving town.
But there were plenty of downsides left. Being a travel nurse first required the ability to travel, which not everyone has, but also usually required extended engagements of weeks or months and often an unsure schedule equally out of the control of the nurses themselves. Being a per diem nurse often means having the ability to turn down individual shifts (and thus have some flexibility over schedule) but still relies on a middle-man to offer shifts to the nurse rather than the nurse choosing between a variety of shifts and selecting what makes the most sense for them that day. But the nurse’s control over their own work is limited - they can only take what’s offered, rather than being able to truly browse available shifts and build their own schedules.
Where Clipboard offers a real difference here is by eliminating a lot of the downsides of having a middleman in between the nurses and the shifts they’d like to work themselves. When a nurse logs on to our app, they see all the shifts available and choose only the work that makes sense for their schedule. They can also choose shifts based on pay, and we’ve worked hard to make sure when they do we can pay them more and more quickly than other options. We have some nurses who have trusted us to provide them with all their shifts, and we often see nurses making >175% what’s typical for a nurse with the same qualifications in their area. Our Instant Pay feature lets nurses get paid as soon as they clock out of their shifts, making it possible for them to use extra work as a tool to cover very short term unexpected needs.
We are constantly looking for ways to improve on this and to take one step further, but don’t get us wrong: we love what we’ve been able to do so far. If a nurse needs flexibility to further their education, they can get it. If they need extra work on top of what they already have, it’s as easy as logging on to the app and getting it. If a nurse wants to control their own career entirely down to the finest details, that’s something they can do. We can always do better for them, and we will; nobody deserves it more. But we’ve come a long way from Florence Nightingale, and we can’t wait to go even further.
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